Whooping cough and measles are back, thanks to anti-vaccination truthers

In recent years there have been outbreaks of diseases once thought to have been eradicated, or at least well controlled.

One example is whooping cough (pertussis).

Pertussis / Whooping cough

Pertussis is a disease caused by a bacterium, and it is highly contagious. It can be spread when an infected patient coughs or sneezes and others in the immediate area inhale the bacteria. It can spread throughout a family, spread in a classroom, church, nursery school or other sites.

In older children and adults, pertussis starts off like a cold. Runny nose, possibly cough and similar symptoms. Over the course of a week or two, a prolonged cough develops. The patient coughs in paroxysms, unable to stop until finally he manages to draw in a long, raspy breath (the “whoop” in whooping cough.) Then the coughing starts again.

whooping cough

Child with whooping cough, courtesy of the CDC.

You can hear the whoop here, courtesy of the CDC, as a child gasps for breath at the end of the paroxysm.

Older children and adults usually manage to get through pertussis after a prolonged convalescence, while the cough continues to persist. In babies, however, the disease can be much more severe, even fatal.

About 50% of babies who have whooping cough will need admitted to a hospital. They can develop pneumonia from the bacterium. And while they may not cough as much as older children, they may stop breathing (apnea) and can die.

The good news is that whooping cough can be prevented by vaccination. Both babies and adults need vaccinated.

In the 1930s, there were hundreds of thousands of cases of pertussis in the US yearly. After the vaccine got into widespread use in the 1950s the cases dropped dramatically.  There were still cases occurring, though. Primarily in people who refused vaccinations for themselves and for their children for religious reasons. Outbreaks tended to occur in these populations.

Anti-vaccination advocates have created a resurgence of pertussis

However as anti-vaccination advocates convinced more people to stop vaccinating in recent year, the number of cases of whooping cough has begun to climb again.  (One of America’s most high-profile anti-vaccinate advocates is Jenny McCarthy of ABC’s “The View.”) There have been recent outbreaks in various areas of the country. Recently, there have been upwards of 50,000 cases of whooping cough per year in the US. In 2012 there were 20 deaths caused by pertussis.

From the CDC.

From the CDC.

Measles are back too

Unfortunately, pertussis isn’t the only disease that was almost eradicated, and now is reemerging. Measles, a virus-caused disease, is making a reappearance.

For years, measles was a rarity in the US. In the prevaccination era, measles was common. It spreads easily. School classmates transmitted it, it spread in families. Before vaccination, almost anyone could recognize a case of measles based on the distinctive rash and associated symptoms. Measles can also be a killer, especially in younger children. They can develop pneumonia, and may develop an encephalitis (an infection of the brain). Either can be fatal.

About 1 or 2 children die from measles for every thousand children who get the disease. Worldwide, tens of thousands of children will die from measles.

In the past few years, the US has averaged about 50-60 cases of measles/year. In 2014, there were already that many cases in just the first two months of the year.  And about 20 cases have been reported in NYC alone this year.

measles-outbreak

Possible reasons for the resurgence include the fact that more people are unvaccinated, and that healthcare workers aren’t used to seeing or thinking about measles, since it’s been relatively rare.

Often measles starts with a fever. Then the child gets a runny nose with a cough, and the whites of the eyes get reddened. These all start before the rash that helps make the diagnosis. Without the rash, the symptoms sound like a lot of other illnesses that young children get: the usual colds, allergies and other diseases. If the doctor or nurse isn’t thinking about measles, because it seems to be rare, the diagnosis can get missed. And the patient can continue to spread the infection to others in the waiting room, school bus or other places before ever being diagnosed himself.

Children and adults need to be vaccinated

These are just two diseases that are reappearing with gradually increasing frequency. The shame is that we have the ability to eradicate them so that they no longer cause illness or death. We haven’t because of people’s failure to be vaccinated, and have their children vaccinated. Smallpox has been eradicated worldwide. Polio has been eradicated in the US. We can do the same for these diseases: pertussis, measles, rubella, mumps and others.

The take-home message is that children and adults need to be vaccinated against these diseases. Not only for their own protection, but to prevent the spread of these diseases to those who may not be able to be vaccinated. Those who are immunocompromised or newborns, for example. If someone in one of those groups gets ill with one of these diseases, it could mean death.

Find out what vaccines adults need here.
And find out what vaccinations children need here.
My previous article about the flu, and why you shouldn’t believe the flu vaccine naysayers.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • PKRipper

    First off you knobs, every 4-5 years there is a Pertussis outbreak, did you know that? This is REGARDLESS of vaccination. Check out the CDC FAQ on Pertussis and you’ll see a question about if people opposed to vaccines are responsible for RISES (not rise) in pertussis cases. EVEN THE CDC ADMITS THESE PEOPLE AREN’T RESPONSIBLE. How about all the vaccinated getting Pertussis? How do you explain this? Let the sheeple continue to poison themselves with misinformation, fear, uncertainty, and doubt. I sincerely pray for anyone who gets pertussis, but to blame it on people who don’t vaccinate is just ignorant. Vaccines have been proven in certain cases and for certain infections and for others there is little proof they work at all. The flu vaccine is the biggest con of all, but I bet most of you run out and get that too. I’m sorry, my child doesn’t need 5 doses of vaccine. I’ll take my chances.

  • Hue-Man

    Maybe the anti-vaccine crowd should be sent off to Afghanistan, Pakistan, and Nigeria to find out how strong their convictions are! NOT India after today’s announcement – eliminating polio from a country with a population of 1.4 BILLION is probably the best “good news” story of 2014.

    “The World Health Organization formally declared India polio-free on Thursday, after three years with no new cases. It said the milestone means the entire Southeast Asian region, home to a quarter of the world’s population, is considered free of the disease.” http://www.cbsnews.com/news/india-officially-declared-polio-free/

  • http://politivajustice.com/ Politiva_com

    Show the timelines back to the turn of the 20th century http://childhealthsafety.wordpress.com/graphs/

  • http://politivajustice.com/ Politiva_com

    The lowest year for whooping cough was 1976 with roughly 10,000 cases yet only 73% of 2 year olds were vaccinated. Today according to the CDC 94% of 2 year olds are vaccinated for whopping cough with 48,000 cases last year. Explain please, pro vacinne folks.
    http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/G/coverage.pdf

  • Inquiring Mind

    When it comes to whooping cough, it is the vaccine that is failing, not vaccination rates. As a doctor, you should be warning the public about the possibility that vaccinated individuals can still be spread the disease even if they have no symptoms of the infection. (Unless you consider the FDA to be an ‘anti-vaccination truther.’ ) Since the agency has not yet been totally captured by the drug industry and AMA, perhaps you do hold that view.
    Another cause of whooping cough spread is doctors repeatedly misdiagnosing infections as bronchitis. Maybe you could educate your comrades and readers about that, Mark, along with calling for research into an improved whooping cough vaccine(s).

    …………………………………………………………………………………..

    FDA NEWS RELEASE
    For Immediate Release: Nov. 27, 2013
    Media Inquiries: FDA- Jennifer Rodriguez, 301-796-8232, jennifer.rodriguez @ fda.hhs.gov
    NIH- Nalini Padmanabhan, 301-402-1663, padmanabhannm @ niaid.nih.gov
    Consumer Inquiries: 888-INFO-FDA,OCOD @f da.hhs.gov

    FDA study helps provide an understanding of rising rates of whooping cough and response to vaccination
    [snip]

    “While the reasons for the increase in cases of whooping cough are
    not fully understood, multiple factors are likely involved, including
    diminished immunity from childhood pertussis vaccines, improved
    diagnostic testing, and increased reporting. With its own funds plus
    support from the National Institutes of Health (NIH), the FDA conducted
    the study to explore the possibility that acellular pertussis vaccines,
    while protecting against disease, might not prevent infection.

    “There
    were 48,000 cases reported last year despite high rates of
    vaccination,” said Anthony S. Fauci, M.D., director of the NIH’s
    National Institute of Allergy and Infectious Diseases. “This resurgence
    suggests a need for research into the causes behind the increase in
    infections and improved ways to prevent the disease from spreading.”

    The
    FDA conducted the study in baboons, an animal model that closely
    reproduces the way whooping cough affects people. The scientists
    vaccinated two groups of baboons – one group with a whole-cell pertussis
    vaccine and the other group with an acellular pertussis vaccine
    currently used in the U. S. The animals were vaccinated at ages two,
    four, and six months, simulating the infant immunization schedule. The
    results of the FDA study found that both types of vaccines generated
    robust antibody responses in the animals, and none of the vaccinated
    animals developed outward signs of pertussis disease after being exposed
    to B. pertussis. However, there were differences in other
    aspects of the immune response. Animals that received an acellular
    pertussis vaccine had the bacteria in their airways for up to six weeks
    and were able to spread the infection to unvaccinated animals. In
    contrast, animals that received whole-cell vaccine cleared the bacteria
    within three weeks.

    This research suggests that
    although individuals immunized with an acellular pertussis vaccine may
    be protected from disease, they may still become infected with the
    bacteria without always getting sick and are able to spread infection to
    others, including young infants who are susceptible to pertussis
    disease.”

  • ANTIVAX

    On November 25th 2013 the Washington Post reported that there was
    mountaing evidence to suggest that the widespread use of the Pertussis
    vaccine (DTaP) was doing more harm than good in the long term and was
    also found to be lacking in effectiveness.

    Tod Merkel of the FDA
    said after researching that while the vaccine may prevent people from
    getting sick in the short term it doesnt prevent the spread of the
    disease and once vaccinated you become an ‘Asymptomatic Carrier’ and
    infect others. This fact dispels the myth of Herd immunity.

    Natural herd immunity and vaccine aquired herd immunity are NOT the same.
    Vaccines
    are designed to trick your body’s immune system into producing an
    immune response that includes making protective antibodies that are
    needed to resist future exposure to the infectious viral or bacterial
    microorganism. However, your body is smarter than that. The artificial
    manipulation of your immune system by vaccines containing lab altered
    bacteria and viruses, as well as chemicals and other ingredients, simply
    does not exactly replicate the response that your immune system mounts
    when naturally encountering the infectious microorganism. This is one
    reason why vaccine policymakers say you need to get “booster” shots
    because vaccine acquired immunity is only temporary and wears off,
    sometimes rather quickly.

    The research I am metioning here was carried out on baboons.

    As reported by Medical Daily:

    “The
    researchers also found something revealing when they looked at the
    specific immune response of each group of monkeys. ‘Although all
    vaccinated and previously infected animals had robust serum antibody
    responses, we found key differences in T-cell immunity,’ the authors
    wrote in PNAS.
    Specifically, previously infected animals and
    whole-cell-vaccinated animals both exhibited the same kind of boost in
    immune response while the acellular pertussis vaccination elicited a
    response that was slightly different. ‘The observation that acellular
    pertussis, which induces an immune response mismatched to that induced
    by natural infection, fails to prevent colonization or transmission,
    provides a plausible explanation for the resurgence of pertussis…’”

    Although
    the FDA researchers say they found differences between immune responses
    to the whole cell DPT vaccine acellular DTaP vaccine, they also admit
    that “neither vaccine was able to prevent colonization as well as
    immunity from a previous infection” and that “relative protection
    afforded by Th17 or Th1 responses in vaccinated or convalescent baboons
    or humans is not known.”
    Bottom line: there are huge gaps in scientific knowledge about both B. pertussis vaccination and B. pertussis infections.

    To
    recap, FDA researchers conducting the featured baboon study found that
    the whole cell pertussis vaccine (GSK’s Infanrix DPT), the acellular
    pertussis vaccine (Sanofi’s Daptacel DTaP), and natural pertussis
    infection all induced high antibody titers in infant baboons. High
    antibody titer after vaccination is currently the gold standard for
    proving that a vaccine confers “immunity” and inability to colonize or
    transmit infection.

    However in this study, high B. pertussis
    antibody titers after vaccination did NOT correlate with immunity and
    inability to colonize or transmit B. pertussis infection to other
    baboons—effectively challenging the idea that high antibody titer
    following vaccination is evidence that vaccination will prevent
    infection in the vaccine recipient and the recipient will not be able to
    infect others. Furthermore, the study authors found that:
    Baboons
    vaccinated with a whole cell pertussis vaccine (DPT) colonized B.
    pertussis upon direct challenge but cleared infection almost twice as
    fast as animals vaccinated with an acellular pertussis vaccine
    (DTaP)—which is the type used by American children since 1996. This
    suggests that children recently given DTaP vaccine, who are exposed to
    B. pertussis may be astymptomatic carriers and transmitters of the
    infection for a longer period of time compared to children who get the
    older, more reactive whole cell DPT vaccine and clear infection more
    quickly.
    Previous B. pertussis infection prevented colonization with
    B. pertussis in baboons better than having received either whole cell
    pertussis (Infanrix) or acelullar pertussis vaccine (Daptacel). In
    short, natural immunity offered greater protection against the ability
    to become infected and transmit infection after exposure to B. pertussis
    than either of the two vaccines.
    That said, the researchers acknowledged the baboon study had limitations and among them were the fact that:
    Baboons
    are not humans and the study authors admitted that “relative protection
    afforded by Th17 and Th1 responses in vaccinated or convalescent
    baboons or humans is not known.”
    Only one type of whole cell DPT and
    one type of acellular DTaP vaccine was used in this study but there are
    many different kinds of DPT and DTaP containing different components.
    Considering the known variability of measured efficacy and effectiveness
    of DPT and DTaP vaccines in clinical studies, the FDA study conclusions
    can only be limited to those two specific DPT and DTaP vaccines.

    This
    study in infant baboons suggests that pertussis vaccine-acquired
    immunity has been an illusion. Although the vaccines may protect against
    severe B. pertussis clinical symptoms of the disease—such as paroxysmal
    coughing—they do not prevent colonization of B. pertussis bacteria and
    transmission of the infection to others.
    In this study at least,
    recovery from previous B. pertussis infection was more effective in
    preventing colonization with B.pertussis upon direct challenge than
    either whole cell DPT (Infanrix) or acellular DTaP (Daptacel) and that
    suggests transmission of the infection to others after exposure to B
    pertussis would also be less likely when there is a history of naturally
    acquired immunity.”

    To sum up it appears that natural aquired immunity lasts a lifetime whereas vaccine induced immunity is temporary.

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  • http://www.rebeccamorn.com/mind BeccaM

    Why yes. Which is why it would be terrific if ‘Displaced Viking’ actually had some.

    But he doesn’t.

  • Harry Wookiee

    Facts is facts.

  • Harry Wookiee

    Is the vaccine any good if one has already been exposed to a carrier?

  • http://AMERICAblog.com/ John Aravosis

    I got the mumps too when I was 4 or 6, that sucked too.

  • docsterx
  • docsterx

    Exactly. S/he’d probably have similar arguments if the thread concerned 9/11, the Malasian Air jet’s disappearance, abortion or any one of a number of other topics.

  • Tatts

    I’m going to assume that anyone who uses the word ‘paroxysm’ just made a typo in the sentence:
    “Both babies and adults need vaccinated.”
    But just to nip that construct in the bud (since I hear it once in a while “it needs rewritten”, “it needs cleaned”, etc)–they need TO BE vaccinated.

  • Monophylos Fortikos

    As a matter of fact, yes. You’re forgetting the whole “‘Western’ medicine is just a conspiracy among the AMA, Big Pharma and the government to keep people sick.”

  • http://www.rebeccamorn.com/mind BeccaM

    Yeah, that was really unpleasant. They’d scratch my arm all up with that pokey thing, and although it hurt like hell for about a day, the requisite lesion just wouldn’t develop. I think on the last try, they used a double dose or a stronger strain or something. Hard to remember for sure, since I was only five or six at the time.

    I also caught the mumps in the 2nd grade…

  • BillFromDover

    Ouch!

  • http://www.rebeccamorn.com/mind BeccaM

    Just a guess? Probably an even worse case, putting me in the hospital.

    I believe my experience was the usual outcome of a vaccination that doesn’t quite do its job — you get the disease, but it’s not quite as bad as it could’ve been.

    For what it’s worth, it didn’t surprise me to get whooping cough, because my responses to vaccines tended to be weak. It required four attempts before the smallpox vaccine ‘took.’

  • http://www.rebeccamorn.com/mind BeccaM

    Selfishness.

    I’d say that’s the one thing you missed. Putting one’s own misinformed beliefs ahead of the well-being, health, and safety of others.

  • BillFromDover

    Got any idea what the outcome would have been without your vaccination?

    Would you care to opine?

  • BillFromDover

    Religion, ignorance and conspiracies, not to mention any combination of all three.

    Have I missed anything?

    And, in these days of technology, how fuckin’ stupid is it that we allow this shit to continue?

  • http://www.rebeccamorn.com/mind BeccaM

    In another era, Mark, our commenter here, ‘displaced viking’, would been among those decrying the ‘dirty Irish’ and the ‘yellow menace.’

    He’s far more interested in scapegoating than in facts or presenting documented evidence.

  • http://www.rebeccamorn.com/mind BeccaM

    Despite the vaccinations, which I did receive, when I was around 17 years old, I developed a bad case of pertussis.

    It was every bit as horrible as that gif and sound recording would suggest. I coughed so hard and so continuously, my entire chest ached all the time and of course my throat felt like it had been sand-blasted. I remember the wheeze/whoop. At first, we (my parents and I) thought I just had a bad cold & cough, but there came one day when the coughing got so bad, my diaphragm began to seize.

    I collapsed near some stairs and had to grab my mother (who was panicking) and, through gestures as I was near to losing consciousness, had her perform a kind of Heimlich maneuver on me, just so I could breathe again.

    Well, we were off to the doctor immediately after that, and while I don’t remember the entire treatment, one thing I do remember is being given a prescription for 90 days worth of codeine cough syrup. That helped stop the coughing fits when nothing else would.

  • BillFromDover

    And I’m sure that you have unvarnished super-statistics proving that only unvaccinated, undocumented immigrants-contract measles, mumps and whooping cough?

  • http://www.rebeccamorn.com/mind BeccaM

    I hear ya. And yeah, that was wrong of your doctor to do that.

    I had a much better one back in California, before we left, with whom I worked in the weeks before heading overseas. Now, I was off insurance at the time (no choice, they refused to cover me), so there were limits to what we could do and what I could afford. But we came up with a plan to cover the various bases, including some basic blood screenings, booster shots, and a prophylactic prescription of antibiotics to be taken only if needed. And we went over what conditions that might prompt such need.

    As it turned out, except for the vaccinations, I didn’t need to worry so much, because there was a truly excellent doctor in the village in Andhra Pradesh where I spent most of my time — and he even made house-calls.

  • http://www.rebeccamorn.com/mind BeccaM

    Xenophobic much?

  • http://www.americablog.com/ Naja pallida

    Working in high risk environments usually requires you update all your vaccinations more as a liability issue than a worry that your original vaccinations were somehow inferior. But really, there’s conflicting data on the length of time vaccinations are effective. Some studies have shown that after about ten years, their effectiveness is greatly reduced for some conditions, like measles, mumps, hepb, etc. Rubella, even less, around five years. So if anyone is at specific risk for coming into contact with those conditions, and haven’t been vaccinated in recent memory, they should discuss it with their doctor.

  • http://www.americablog.com/ Naja pallida

    Where exactly are all these diseased undocumented immigrants coming from? Mexico requires vaccination of all elementary school age children. There was a study released just recently that showed Mexico is more effective at vaccinating their children than the US is, by nearly 20%. They’ve even recently started vaccinating for HPV. Plus, their childhood vaccinations are free. Children are lined up in school and vaccinated en masse.

    About the only outlier is tuberculosis, with just over half of new cases coming from foreign born persons, but tuberculosis isn’t something anyone regularly immunizes for unless there is a specific risk of exposure.

  • emjayay

    Different but something in common: Dr. Ben Carson.

  • Mike_in_the_Tundra

    This has a lot to do with my pet peeve about my doctor (in many respects, he’s great). If he runs a test, I want to know everything he is testing. I requested a HIV test. He also ran tests for syphilis and hepatitis. That makes sense, but I wish to know what tests he’s running. I guess I’m the same with vaccinations.

  • http://www.rebeccamorn.com/mind BeccaM

    Aye — that was the booster I got before my wife and I traveled to India in ’06.

  • docsterx

    displaced viking, a few things about your reasoning.

    1. If the US population is uniformly vaccinated against the infectious diseases mentioned above, it would have no bearing on whether there were unvaccinated immigrants carrying the diseases into the US. The US population would have a very high level of immunity since it was vaccinated.

    2. Unvaccinated US citizens who travel to areas where these diseases may be endemic can easily catch them there and bring them back to the US. Should we forbid foreign travel for that reason? And some countries that still harbor measles are hardly thrid world. Some recent US cases of measles were traced back to unvaccinated US citizens who were exposed to measles in the EU and then brought measles back to the US. Based on your thinking we should prohibit all immigration into the US and all travel outside of the US.

    3. Polio has been eradicated in the US for about 25 years. The influx of third world immigrants has not brought polio back to infect US residents.

    4. You make a sweeping statement that undocumented immigrants are unvaccinated. There are many vaccines directed against different diseases. Which vaccines haven’t they been given? How do you know that?

  • displaced viking

    Public Health is a very important preventative medical practice nationally and internationally. Disease is always a concern, and endemic diseases turning pandemic is a grave concern. However, Dr. Thoma, your writing is misleading by laying blame for the public health risk on “anti-vaccination advocates”, is intellectually dishonest. What does pose a high concern in the public health community, and is not address in your article above, but should be, are the influx of third world immigrant coming into the U.S., bringing third world diseases, once eradicated from the U.S, to levels shown in this article and lower, now are on the rise. There has to be a cause for there to be an affect. Undocumented immigrants are not vaccinated and pose a serious health risk to public health. This health risk has been known, and is not publicly addressed due to political correctness.

  • displaced viking

    In your statement, you just identified yourself as “functional but neurologically-flawed” individual. Congrats!

  • phred

    Another point: the vaccines given to children in the 1960s weren’t as effective as the ones available today. I got all the standard vaccinations when I was a baby, but when I started working in a hospital I had to get them again.

  • loona_c

    It used to be thought that if you had these diseases as a child you were immune. But not necessarily. I’m old enough to have had everything (except mumps) as a child. Yet when I was considering getting pregnant my OB checked my “titer” for measles and it was low. Which meant if exposed to measles while pregnant the baby and I could have gotten it. I had to get an immunization for it (which actually made me ill with a fever for 4 days).

  • http://musephotos.wordpress.com/ GarySFBCN

    I believe that many people who are quick to consider everything a conspiracy probably share a common neurological trait. I’d consider grouping ‘libertarians’ and anyone else who is unable to experience empathy into that same group of functioning but neurologically-flawed people.

  • http://musephotos.wordpress.com/ GarySFBCN

    Yep, the anti-vaccination idiots in the US are afraid of the CIA. Or something.

  • HeartlandLiberal

    We have relative, a cousin and her husband, who believe the totally debunked autism claims pinned on vaccines. They both work for Rand Corp. Brilliant mathematicians. But lacking in wisdom. I cannot comprehend their belief system.

  • bkmn

    Many thanks for providing this very important information. It is truly shameful that misinformed people are putting so many others at risk.

  • bkmn

    You most likely got a dose of the Tdap vaccine which covers tetanus, diptheria and pertussis.

    Check the link Dr. Thoma provided near the bottom about adult vaccines for more info.

  • Mike_in_the_Tundra

    Here’s a chance to get a little information. A year or so ago, I asked my doctor if I needed a pertussis vaccination before visiting my grandchildren. His answer was that it was included in my recent tetanus booster. Did I get that right?

  • MyrddinWilt

    And don’t forget that one of the reasons it is now hard to get vaccination programs going in Pakistan is that the CIA tried to get blood from Bin Ladens children to confirm their ID by posing as doctors doing a vaccination program.

    There is a similar problem in Nigeria with Polio. It is hardly surprising that people believe the claim of a link to the origins of AIDS when the response of the Western medical establishment is to sue for libel rather than investigate. Whether or not the theory was correct, it should have been investigated. But the bigger problem is that Western drug companies went to Nigeria to perform clinical trials that would never have been approved in the US. The local population took the risk of testing but weren’t even offered the benefit until decades after the cure had been deployed in the West and that only because the West in its magnificence has decided that eradicating the diseases worldwide is the best way to protect their own populations.

    Rather than merely accepting vaccination, the health outcome the West wants, the communities would actually best serve their people’s health interests by holding out for rather more than the vaccinations. They should demand hospitals and clinics in the remote areas and reliable supplies of drugs. Vaccinations in those areas might save hundreds of lives but the West can easily afford to provide health services that will save tens of thousands.

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